To explore the influence of dulaglutide combined with dapagliflozin on renal function and fibrosis in patients with type 2 diabetic kidney disease (T2DKD).

This study was a prospective randomized controlled trial. Consecutive patients with T2DKD admitted to our hospital from January 2024 to December 2024 were enrolled and randomly assigned to an observation group and a control group. All patients received basic routine treatment for diabetes. The control group was treated with dapagliflozin monotherapy, while the observation group received additional intervention with dulaglutide injection on the basis of dapagliflozin. Levels of renal function, renal fibrosis markers, and inflammatory factors were measured and compared between the two groups at baseline and 12-month follow-up. Adverse events during treatment were also recorded. Inter-group comparisons were performed using the t-test and Pearson χ² test.

A total of 94 patients with T2DKD were enrolled in this study, with 47 patients in the observation group and 47 in the control group. All the patients completed 12-month standardized treatment. After treatment, the estimated glomerular filtration rate (eGFR) was significantly increased in both groups compared with baseline, and post-treatment eGFR in the observation group was markedly higher than that in the control group (P<0.05). After treatment, the urine albumin-to-creatinine ratio (UACR), serum creatinine (Scr), blood urea nitrogen (BUN), renal fibrosis markers including transforming growth factor-β1 (TGF-β1), connective tissue growth factor (CTGF), kidney injury molecule-1 (KIM-1), as well as inflammatory factors including high-sensitivity C-reactive protein (hs-CRP), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were obviously decreased in both groups relative to baseline; moreover, these indicators in the observation group were significantly lower than those in the control group (P<0.05). Glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) were significantly reduced in both groups after treatment (P<0.05), whereas no statistically significant inter-group differences in HbA1c and FPG were observed after treatment. There was no significant difference in the incidence of adverse events between the two groups during the treatment period.

Dulaglutide combined with dapagliflozin can better preserve renal function, inhibit renal fibrosis, and reduce systemic inflammatory response in patients with T2DKD. Its glucose-lowering efficacy is comparable to dapagliflozin monotherapy, with favorable safety profile.